BOSTON – When Ashok and Vinita Rampuria’s son returned home after a year off from college to complete his coursework, he didn’t seem like himself.
“He failed to complete the tasks. He was lying on the couch,” said Ashok Rampuria, a resident of Acton, Massachusetts. “He took some jobs, but he couldn’t keep them.”
In 2011, his son was diagnosed with what Rampuria described as severe mental illness. He soon began to be in and out of health care facilities, appearing to get his illness under control, and then bounced back after being released. In 2021, the couple said their son had been using a new drug and had been able to hold down a job for three months, but had not continued taking the drug.
All the while, Rampuria said he and his wife lacked a key tool — a judge’s authority to order their now 36-year-old son, who is currently in a psychiatric hospital in Lynn, Mass., into mandatory outpatient care.
Massachusetts, along with Connecticut and Maryland, are the only states that do not give courts such powers.
“It’s a revolving door. They will send him to hospital for a while, then release him and if he doesn’t take his medicine, he will come back,” said Rampuria. “If our son can stay in treatment continuously for a year, he will achieve what he wants to achieve, hold down a job and live independently.”
A bill before Massachusetts lawmakers would allow family members and mental health professionals to ask courts to order outpatient psychiatric care for adults with persistent mental illness and a significant history of serious physical harm to themselves or others.
The court would have the power to order a personalized treatment plan, including a monthly evaluation by a mental health professional to see if the person should remain in court-ordered treatment in the community, according to the bill’s author, Democratic Sen. Cindy Friedman. The bill is still in the very early stages of moving through the legislature.
Friedman said the legislation relies in part on what she called the “black robe” effect — the idea that a treatment plan ordered by a judge is more likely to be followed by the patient. She also rejected criticism that mental health care should only be provided to those who seek it.
“You don’t solve the problem of undertreatment by denying people who need treatment treatment,” she said. “It’s about a very specific subset of people who don’t know how sick they are.”
Friedman said there can be potentially tragic consequences when the state lets the severely mentally ill fall through the cracks. She pointed to the 2018 death of a medical student at a public library in Winchester, Massachusetts, by a man who was diagnosed with schizophrenia in high school and later hospitalized multiple times for his mental illness.
He was found not guilty by reason of insanity in 2021.
Other states have also grappled with the problem, driven in part by concerns about homeless people who have mental illnesses.
California Gov. Gavin Newsom, a Democrat, last year signed legislation to create new “courts of care” aimed at getting people with mental health problems off the streets and into treatment. In Oregon, some lawmakers have pushed to expand the ability to compel people to get mental health care.
In New York City, Democratic Mayor Eric Adams announced in November that he wants police and city medics to be more aggressive in getting seriously mentally ill people off the streets and subways and into treatment.
In Connecticut, Republican state Rep. John Piscopo proposed a bill this year that would allow probate courts to order individuals with mental disabilities or substance use disorders involuntary medical evaluation and assisted outpatient treatment. The bill did not receive enough support.
“It’s a very, very small population that would require that, and I don’t understand the opposition from advocates,” Piscopo said.
Some people with mental illness don’t have the cognitive ability to pursue treatment, while others don’t recognize that they have a disability, according to Lisa Daly, executive director of the Treatment Advocacy Center, a national nonprofit focused on removing barriers to treatment for people with mental illness. .
“You want someone to stay stable long enough to realize they’re doing better with treatment and continue that on their own,” she said. “Research shows that it takes six months for treatment to stabilize and no one stays that long in hospital.”
But critics argue that forcing someone into mental health care can backfire. They say the mentally ill already face a number of risks.
There are other strategies that are voluntary, from peer counseling to creating spaces where people can talk about their struggles, according to Sera Davidow, director of the Wildflower Alliance, a nonprofit that opposes mandatory outpatient care.
“People who want resources can’t get them, and people who don’t want them are forced,” she said. “Both are harmful.”
Elliot Olson, a Connecticut resident who also opposes mandatory care, said he struggled with depression as a high school student and was given an ultimatum to accept mandatory outpatient care or drop out of school.
“I didn’t want to be there. Everyone else I was with didn’t want to be there. There was just a huge lack of understanding and empathy,” said Olson, 30, who works for the nonprofit PeerPride, which focuses in part on addressing homelessness in the transgender community.
Olson said he had been in the program about six months when the school recommended he be institutionalized. His mother refused, he said.
“I wasn’t going to participate in something I had no choice in,” he said.
In Boston, a voluntary treatment program aims to help people with serious mental illness who have pending criminal charges or are on probation. Launched in 2020, the Boston Outpatient Assisted Treatment Initiative has served 165 individuals, with 33 successfully completing the program.
Massachusetts Gov. Maura Healey, a Democrat, said she welcomes the continued debate about access to mental health care.
“It’s really important that people have access to the mental health care they need and that we also balance individual rights in the process,” Healy said.
Associated Press reporter Susan Hay in Hartford, Conn., contributed to this report.
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